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Davies E. 'This has given me the peace of mind I needed': ethnographic insights into Barrett's oesophagus screening using the capsule sponge test. JOURNAL OF MEDICAL ETHICS 2024:jme-2024-109928. [PMID: 38955478 DOI: 10.1136/jme-2024-109928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 06/14/2024] [Indexed: 07/04/2024]
Abstract
In 2021 and 2022, researchers carried out an implementation trial that considered how the capsule sponge test might be used to screen for Barrett's oesophagus using a mobile clinic in East Anglia. This paper offers insights from 15 months of ethnographic fieldwork studying the trial. It aims to highlight the value of the test in offering reassurance to worried patients, particularly to those with a family history of oesophageal adenocarcinoma. It also considers the variety of aims people held for the capsule sponge test, including the hope that it would address their symptoms of acid reflux, and the conflict that sometimes emerged as a result. The second half of the paper uses fieldwork carried out in virtual support groups for people with Barrett's oesophagus to explore experiences postdiagnosis, which sometimes were defined by fear of future cancers. It describes notable differences between the care offered to people with morphological risk conditions like Barrett's oesophagus and the care given to those with genetic risk conditions, including the provision of genetic counselling. More broadly, the paper highlights a tension between patient-centred and risk-centred medicine that is likely to grow as healthcare services continue to shift towards preventative approaches.
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Affiliation(s)
- Elspeth Davies
- Social Anthropology, University of Cambridge, Cambridge, UK
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2
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Pekala KR, Shill DK, Austria M, Langford AT, Loeb S, Carlsson SV. Shared decision-making before prostate cancer screening decisions. Nat Rev Urol 2024; 21:329-338. [PMID: 38168921 PMCID: PMC11250989 DOI: 10.1038/s41585-023-00840-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 01/05/2024]
Abstract
Decisions around prostate-specific antigen screening require a patient-centred approach, considering the benefits and risks of potential harm. Using shared decision-making (SDM) can improve men's knowledge and reduce decisional conflict. SDM is supported by evidence, but can be difficult to implement in clinical settings. An inclusive definition of SDM was used in order to determine the prevalence of SDM in prostate cancer screening decisions. Despite consensus among guidelines endorsing SDM practice, the prevalence of SDM occurring before the decision to undergo or forgo prostate-specific antigen testing varied between 11% and 98%, and was higher in studies in which SDM was self-reported by physicians than in patient-reported recollections and observed practices. The influence of trust and continuity in physician-patient relationships were identified as facilitators of SDM, whereas common barriers included limited appointment times and poor health literacy. Decision aids, which can help physicians to convey health information within a limited time frame and give patients increased autonomy over decisions, are underused and were not shown to clearly influence whether SDM occurs. Future studies should focus on methods to facilitate the use of SDM in clinical settings.
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Affiliation(s)
- Kelly R Pekala
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Mia Austria
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Aisha T Langford
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Stacy Loeb
- Department of Population Health, New York University, New York, NY, USA
- Department of Urology, New York University and Manhattan Veterans Affairs Medical Center, New York, NY, USA
| | - Sigrid V Carlsson
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
- Department of Translational Medicine, Division of Urological Cancers, Medical Faculty, Lund University, Lund, Sweden.
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Kwong FL, Davenport C, Sundar S. Evaluating the Harms of Cancer Testing-A Systematic Review of the Adverse Psychological Correlates of Testing for Cancer and the Effectiveness of Interventions to Mitigate These. Cancers (Basel) 2023; 15:3335. [PMID: 37444445 DOI: 10.3390/cancers15133335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
(1) Background: Several studies have described the psychological harms of testing for cancer. However, most were conducted in asymptomatic subjects and in cancers with a well-established screening programme. We sought to establish cancers in which the literature is deficient, and identify variables associated with psychological morbidity and interventions to mitigate their effect. (2) Methods: Electronic bibliographic databases were searched up to December 2020. We included quantitative studies reporting on variables associated with psychological morbidity associated with cancer testing and primary studies describing interventions to mitigate these. (3) Results: Twenty-six studies described individual, testing-related, and organisational variables. Thirteen randomised controlled trials on interventions were included, and these were categorised into five groups, namely the use of information aids, music therapy, the use of real-time videos, patient navigators and one-stop clinics, and pharmacological or homeopathic therapies. (4) Conclusions: The contribution of some factors to anxiety in cancer testing and their specificity of effect remains inconclusive and warrants further research in homogenous populations and testing contexts. Targeting young, unemployed patients with low levels of educational attainment may offer a means to mitigate anxiety. A limited body of research suggests that one-stop clinics and patient navigators may be beneficial in patients attending for diagnostic cancer testing.
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Affiliation(s)
- Fong Lien Kwong
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Clare Davenport
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Sudha Sundar
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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4
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Cavers D, Nelson M, Rostron J, Robb KA, Brown LR, Campbell C, Akram AR, Dickie G, Mackean M, van Beek EJR, Sullivan F, Steele RJ, Neilson AR, Weller D. Understanding patient barriers and facilitators to uptake of lung screening using low dose computed tomography: a mixed methods scoping review of the current literature. Respir Res 2022; 23:374. [PMID: 36564817 PMCID: PMC9789658 DOI: 10.1186/s12931-022-02255-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/17/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Targeted lung cancer screening is effective in reducing mortality by upwards of twenty percent. However, screening is not universally available and uptake is variable and socially patterned. Understanding screening behaviour is integral to designing a service that serves its population and promotes equitable uptake. We sought to review the literature to identify barriers and facilitators to screening to inform the development of a pilot lung screening study in Scotland. METHODS We used Arksey and O'Malley's scoping review methodology and PRISMA-ScR framework to identify relevant literature to meet the study aims. Qualitative, quantitative and mixed methods primary studies published between January 2000 and May 2021 were identified and reviewed by two reviewers for inclusion, using a list of search terms developed by the study team and adapted for chosen databases. RESULTS Twenty-one articles met the final inclusion criteria. Articles were published between 2003 and 2021 and came from high income countries. Following data extraction and synthesis, findings were organised into four categories: Awareness of lung screening, Enthusiasm for lung screening, Barriers to lung screening, and Facilitators or ways of promoting uptake of lung screening. Awareness of lung screening was low while enthusiasm was high. Barriers to screening included fear of a cancer diagnosis, low perceived risk of lung cancer as well as practical barriers of cost, travel and time off work. Being health conscious, provider endorsement and seeking reassurance were all identified as facilitators of screening participation. CONCLUSIONS Understanding patient reported barriers and facilitators to lung screening can help inform the implementation of future lung screening pilots and national lung screening programmes.
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Affiliation(s)
- Debbie Cavers
- Usher Institute, University of Edinburgh, Doorway 1, Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
| | - Mia Nelson
- Usher Institute, University of Edinburgh, Doorway 1, Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
| | - Jasmin Rostron
- The National Institute of Economic and Social Research, 2 Dean Trench Street, London, NW1P 3HE UK
| | - Kathryn A. Robb
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ UK
| | - Lynsey R. Brown
- School of Medicine, University of St. Andrews, North Haugh, St. Andrews, KY16 9TF UK
| | - Christine Campbell
- Usher Institute, University of Edinburgh, Doorway 1, Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
| | - Ahsan R. Akram
- MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Graeme Dickie
- Usher Institute, University of Edinburgh, Doorway 1, Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
| | - Melanie Mackean
- Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU UK
| | - Edwin J. R. van Beek
- Edinburgh Imaging, Queen’s Medical Research Institute, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4TJ UK
| | - Frank Sullivan
- School of Medicine, University of St. Andrews, North Haugh, St. Andrews, KY16 9TF UK
| | - Robert J. Steele
- School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY UK
| | - Aileen R. Neilson
- Usher Institute, University of Edinburgh, Doorway 1, Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
| | - David Weller
- Usher Institute, University of Edinburgh, Doorway 1, Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
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Norddal GA, Wifstad Å, Lian OS. ‘It’s like getting your car checked’: the social construction of diabetes risk among participants in a population study. HEALTH, RISK & SOCIETY 2022. [DOI: 10.1080/13698575.2022.2028742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Guri Annesdotter Norddal
- Department of Community Medicine, UiT the Arctic University of Norway, Faculty of Health Sciences, Tromsø, Norway
| | - Åge Wifstad
- Department of Community Medicine, UiT the Arctic University of Norway, Faculty of Health Sciences, Tromsø, Norway
| | - Olaug S. Lian
- Department of Community Medicine, UiT the Arctic University of Norway, Faculty of Health Sciences, Tromsø, Norway
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Zhu J, Ma S, Chen R, Liu Z, Liu Z, Wei W. The psychological impact of esophageal cancer screening on anxiety and depression in China. Front Psychiatry 2022; 13:933678. [PMID: 36339848 PMCID: PMC9630588 DOI: 10.3389/fpsyt.2022.933678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 10/06/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The psychological impact of screening is unclear and has been ignored. This study aimed to evaluate the psychological impact of esophageal cancer (EC) screening on anxiety and depression in China. MATERIALS AND METHODS A multicenter, population-based study in five high-risk regions of EC was conducted from 2019 to 2020. Residents were recruited and underwent endoscopic screening and then were diagnosed with normal, esophagitis, low-grade intraepithelial neoplasia (LGIN), high-grade intraepithelial neoplasia (HGIN) and EC. Subjects who did not participate in the screening were referred to as the control group. We surveyed their anxiety and depression levels at baseline and after endoscopy and informed them of different pathological results to evaluate the psychological impact of the screening process. RESULTS A total of 2,337 subjects completed all surveys in the screening process (normal: 355, esophagitis: 1,713, LGIN: 213, HGIN: 43 and EC: 13), with 63 controls. The levels of anxiety and depression of screeners were significantly higher than those of controls (P < 0.001). The fluctuation of anxiety and depression showed a "V" pattern in the screening process. The prevalence of anxiety symptoms at baseline, after endoscopy and after knowing the pathological results was 5.6, 0.3, and 3.2%, respectively (P < 0.001), and the corresponding prevalence of depression was 3.6, 0.2, and 2.1%, respectively (P < 0.001). With the aggravation of pathological results, the levels of anxiety and depression increased significantly (P < 0.001), especially in patients informed of HGIN (16.3 and 9.3%) and EC (23.1 and 30.8%). CONCLUSION Participation in endoscopic screening may bring short-term adverse psychological effects, especially at baseline and knowing the pathological results. More attention should be given to participants waiting for endoscopic screening. The method of informing the screening results of HGIN and EC should be improved. Further precise screening is needed to concentrate on high-risk groups to reduce the psychological impact of screening.
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Affiliation(s)
- Juan Zhu
- National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Cancer Prevention, The Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Institute of Cancer and Basic Medicine, Chinese Academy of Sciences, Hangzhou, China
| | - Shanrui Ma
- National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ru Chen
- National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhaorui Liu
- Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China
| | - Zhengkui Liu
- Chinese Academy of Sciences, Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
| | - Wenqiang Wei
- National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Broadbent R, Gorman L, Armitage CJ, Radford J, Linton K. The perspectives of survivors of Hodgkin lymphoma on lung cancer screening: A qualitative study. Health Expect 2021; 25:116-124. [PMID: 34755419 DOI: 10.1111/hex.13353] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/21/2021] [Accepted: 08/12/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Hodgkin lymphoma survivors (HLS) are at excess risk of lung cancer as a consequence of HL treatment. HLS without a heavy smoking history are currently unable to access lung cancer screening (LCS) programmes aimed at ever smokers, and there is an unmet need to develop a targeted LCS programme. In this study we prospectively explored HLS perspectives on a future LCS programme, including motivating factors and potential barriers to participation, with the aim of identifying ways to optimise uptake in a future programme. METHODS Semistructured telephone interviews were conducted with HLS, aged 18-80 and lymphoma-free for ≥5 years, selected from a clinical database (ADAPT). Participants provided informed consent. Data were analysed using inductive thematic analysis. RESULTS Despite awareness of other late effects, most participants were unaware of their excess risk of lung cancer. Most were willing to participate in a future LCS programme, citing the potential curability of early-stage lung cancer and reassurance as motivating factors, whilst prior experience of healthcare was a facilitator. Whilst the screening test (a low dose CT scan) was considered acceptable, radiation risk was a concern for some and travel and time off work were potential barriers to participation. CONCLUSIONS Our results suggest that most HLS would participate in a future LCS programme, motivated by perceived benefits. Their feedback identified a need to develop educational materials addressing lung cancer risk and concerns about screening, including radiation risk. Such materials could be provided upon an invitation to LCS. Uptake in a future programme may be further optimized by offering flexible screening appointments close to home.
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Affiliation(s)
- Rachel Broadbent
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK.,The Christie NHS Foundation Trust, Manchester, UK
| | - Louise Gorman
- NIHR Greater Manchester Patient Safety Translational Research Centre, Centre for Mental Health and Safety, Division of Population Health, Health Services Research & Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Christopher J Armitage
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK.,Manchester Centre for Health Psychology, Division of Psychology and Mental Health, University of Manchester, Manchester, UK.,Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - John Radford
- Manchester Cancer Research Centre, Manchester, UK
| | - Kim Linton
- Manchester Cancer Research Centre, Manchester, UK
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8
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Colorectal Cancer Screening: Have We Addressed Concerns and Needs of the Target Population? GASTROINTESTINAL DISORDERS 2021. [DOI: 10.3390/gidisord3040018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Despite the recognized benefits of colorectal cancer (CRC) screening, uptake is still suboptimal in many countries. In addressing this issue, one important element that has not received sufficient attention is population preference. Our review provides a comprehensive summary of the up-to-date evidence relative to this topic. Four OVID databases were searched: Ovid MEDLINE® ALL, Biological Abstracts, CAB Abstracts, and Global Health. Among the 742 articles generated, 154 full texts were selected for a more thorough evaluation based on predefined inclusion criteria. Finally, 83 studies were included in our review. The general population preferred either colonoscopy as the most accurate test, or fecal occult blood test (FOBT) as the least invasive for CRC screening. The emerging blood test (SEPT9) and capsule colonoscopy (nanopill), with the potential to overcome the pitfalls of the available techniques, were also favored. Gender, age, race, screening experience, education and beliefs, the perceived risk of CRC, insurance, and health status influence one’s test preference. To improve uptake, CRC screening programs should consider offering test alternatives and tailoring the content and delivery of screening information to the public’s preferences. Other logistical measures in terms of the types of bowel preparation, gender of endoscopist, stool collection device, and reward for participants can also be useful.
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Abstract
Screening for pancreatic cancer (PC) in high-risk groups aimed to detect early cancers is currently done only in the research setting, and data on psychological outcomes of screening in these populations is scarce. To determine the psychological impact of a national Australian pancreatic screening program, a prospective study was conducted using validated psychological measures: impact of events scale (IES), psychological consequences questionnaire (PCQ) and the cancer worry scale. Measures were administered at baseline, 1-month and at 1-year post-enrolment and correlations with abnormal endoscopic ultrasound (EUS) results were calculated. Over a 6-year period, 102 participants were recruited to the screening program. Thirty-nine patients (38.2%) had an abnormal endoscopic ultrasound, and two patients (2.0%) were diagnosed with PC and two with other malignancies. Those with a personal history of cancer or a positive BRCA2 mutation demonstrated significantly increased worry about developing other types of cancer at baseline (p < 0.01). Irrespective of EUS result, there was a significant decrease of total IES score at 1 year (Z = - 2.0, p = 0.041). In patients with abnormal EUS results, there was a decrease in the total IES score at 1 year (Z = - 2.5, p = 0.011). In participants deemed to be most distressed at baseline based on their negative PCQ score, there was a significant decrease of the total PCQ (Z = - 3.2, p = 0.001), emotional (Z = - 3.0, p = 0.001), social (Z = 3.0, p = 0.001) and physical (Z = - 2.8, p = 0.002) subscale at 1-year post-intervention. This study provides evidence of the long-term psychological benefits of PC screening in high-risk patients. There was no negative impact of screening in the short-term and the positive benefits appeared at 1-year post-intervention irrespective of screening result.
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Abstract
This article gives an overview of the current state of the evidence for prostate cancer early detection with prostate-specific antigen (PSA) and summarizes current recommendations from guideline groups. The article reviews the global public health burden and risk factors for prostate cancer with clinical implications as screening tools. Screening studies, novel biomarkers, and MRI are discussed. The article outlines 7 key practice points for primary care physicians and provides a simple schema for facilitating shared decision-making conversations.
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Affiliation(s)
- Sigrid V Carlsson
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY 10065, USA.
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11
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Ramezani Doroh V, Delavari A, Yaseri M, Emamgholipour Sefiddashti S, Akbarisari A. Preferences of Iranian average risk population for colorectal cancer screening tests. Int J Health Care Qual Assur 2019; 32:677-687. [PMID: 31111783 DOI: 10.1108/ijhcqa-08-2017-0151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to explore the preferences of the average risk Iranian population for colorectal cancer (CRC) screening tests. DESIGN/METHODOLOGY/APPROACH A standard stated-preferences method with discrete choice models was used to identify the preferences. Data about socio-demographic status, health status and preferences for CRC screening tests were collected by a structured questionnaire that was completed by 500 people aged 50-75 years. Mixed logit model was used to analyze the preferences. FINDINGS The regression model showed that the test process, pain, place, frequency, preparation, sensitivity, complication risk, mortality rate and cost were the final attributes; that had a statistically significant correlation with the preferences of the people in choosing CRC screening tests. The socio-demographic and health status of participants had no significant correlation with the individuals' preferences. PRACTICAL IMPLICATIONS This study provides insight into how different characteristics of a CRC screening test might influence the preferences of individuals about that test. ORIGINALITY/VALUE This was the first study of this type in Iran to elicit the preferences of the average risk population for CRC screening tests using a discrete choice model.
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Affiliation(s)
- Vajiheh Ramezani Doroh
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences , Tehran, The Islamic Republic of Iran
| | - Alireza Delavari
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences , Tehran, The Islamic Republic of Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences , Tehran, The Islamic Republic of Iran
| | - Sara Emamgholipour Sefiddashti
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences , Tehran, The Islamic Republic of Iran
| | - Ali Akbarisari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences , Tehran, The Islamic Republic of Iran
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12
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Gavaruzzi T, Sarlo M, Giandomenico F, Rumiati R, Polato F, De Lazzari F, Lotto L. Assessing emotions conveyed and elicited by patient narratives and their impact on intention to participate in colorectal cancer screening: A psychophysiological investigation. PLoS One 2018; 13:e0199882. [PMID: 29953535 PMCID: PMC6023155 DOI: 10.1371/journal.pone.0199882] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 06/17/2018] [Indexed: 12/22/2022] Open
Abstract
In the context of colorectal cancer screening, we aimed to compare the effectiveness of different emotion-laden narratives, to investigate the specific emotions elicited at both subjective and physiological levels, and to test the effects of emotions explicitly expressed by the narrative character. Study 1 used a between-participants design comparing four conditions: relief-based narrative, regret-based narrative, control (test-uptake only) narrative, and standard invitation material (no-narrative condition). Study 2 used a mixed design, with the narrative content as a within-participants factor and whether emotions were expressed by the narrative character or not as between-participants factor. The main outcome measures were: intention to undergo testing (Studies 1 and 2), knowledge, risk perception, proportion of informed choices (Study 1), subjective emotional responses, changes in skin conductance, heart rate, and corrugator muscle activity (Study 2). In Study 1, relative to the non-narrative condition (51%), only the relief-based narrative significantly increased intention to undergo testing (86%). Relative to the standard invitation material, the narrative conditions did not decrease knowledge, alter risk perception, or decrease the proportion of informed choices. In Study 2, the relief-based narrative elicited the lowest self-reported negative affect, and received greater implicit attention, as suggested by the larger heart rate decrease. Making the emotions experienced by the narrative character explicit decreased negative affect, as indicated by the lower skin conductance and corrugator responses during reading. Our findings provide support for the use of a relief-based narrative with emotions expressed by the character in addition to the standard information material to promote colorectal cancer screening.
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Affiliation(s)
- Teresa Gavaruzzi
- Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy
- * E-mail:
| | - Michela Sarlo
- Department of General Psychology, University of Padova, Padova, Italy
- Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Francesca Giandomenico
- Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy
| | - Rino Rumiati
- Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy
| | | | | | - Lorella Lotto
- Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy
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Barnett KN, Weller D, Smith S, Orbell S, Vedsted P, Steele RJC, Melia JW, Moss SM, Patnick J, Campbell C. Understanding of a negative bowel screening result and potential impact on future symptom appraisal and help-seeking behaviour: a focus group study. Health Expect 2016; 20:584-592. [PMID: 27414462 PMCID: PMC5512994 DOI: 10.1111/hex.12484] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2016] [Indexed: 12/19/2022] Open
Abstract
Background Colorectal cancer (CRC) screening using a faecal occult blood test (FOBt) has the potential to reduce cancer‐related mortality. Symptom vigilance remains crucial as a proportion of cancers will be diagnosed between screening rounds. A negative FOBt has the potential to influence how participants respond to future symptoms of CRC. Objective To explore (i) understanding of a negative FOBt and (ii) the potential impact of a negative FOBt upon future symptom appraisal and help‐seeking behaviour. Design Qualitative methodology utilizing focus groups with participants who received a negative FOBt within the National Bowel Cancer Screening Programme in Coventry and Lothian. Topics explored included: experience of screening participation, interpretation and understanding of a negative result, symptom awareness and attitudes towards help‐seeking. Results Four broad themes were identified: (i) emotional response to a negative FOBt, (ii) understanding the limitations of FOBt screening, (iii) symptom knowledge and interpretation and (iv) over‐reassurance from a negative FOBt. Participants were reassured by a negative FOBt, but there was variability in the extent to which the result was interpreted as an “all clear”. Some participants acknowledged the residual risk of cancer and the temporal characteristic of the result, while others were surprised that the result was not a guarantee that they did not have cancer. Discussion and conclusions Participants recognized that reassurance from a negative FOBt could lead to a short‐term delay in help‐seeking if symptoms developed. Screening programmes should seek to emphasize the importance of the temporal nature of FOBt results with key messages about symptom recognition and prompt help‐seeking behaviour.
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Affiliation(s)
| | | | - Steve Smith
- Midlands and NW Bowel Cancer Screening Programme Hub, UHCW NHS Trust, Rugby, UK
| | | | | | | | | | - Sue M Moss
- Queen Mary University of London, London, UK
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14
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Rosenberg MT, Spring AC, David Crawford E. Prostate cancer and the PCP: the screening dilemma. Int J Clin Pract 2015; 69:1438-47. [PMID: 26459772 DOI: 10.1111/ijcp.12745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
| | - A C Spring
- Mid Michigan Health Centers, Jackson, MI, USA
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Abstract
In 2012, the U.S. Preventive Services Task Force (USPSTF) issued a blanket "D" recommendation against all prostate-specific antigen (PSA)-based early detection efforts for prostate cancer, reflecting critical misinterpretations of the major evidence regarding benefits and harms of such testing. Against the backdrop of the ensuing controversy, in 2013 the American Urological Association (AUA) published a new, methodologically rigorous guideline. This guideline recommended that men aged 55-69 be offered biennial screening in the setting of shared decision-making, that men under 40 or over 69 years of age should not be screened routinely, and that evidence was insufficient to recommend screening for men aged 40-54 years. While it has received criticism with regard to the age-based recommendations, the AUA guideline reflects a far better and more balanced presentation of the available evidence than the USPSTF statement. However, because the USPSTF is far more influential than the AUA among primary care providers, the ultimate impact of the new AUA guideline on practice patterns may be limited. Optimizing early detection practices should involve consensus-building incorporating both primary care and specialist input, with the goals of minimizing overtreatment of low-risk disease while continuing to reduce prostate cancer mortality rates through early detection and aggressive management of high-risk disease.
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Affiliation(s)
- Matthew R Cooperberg
- Departments of Urology and Epidemiology & Biostatistics, University of California, San Francisco, Box 1695, 1600 Divisadero Street, A-624, San Francisco, CA, 94143-1695, USA,
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McDowell ME, Occhipinti S, Chambers SK. Classifying the reasons men consider to be important in prostate-specific antigen (PSA) testing decisions: evaluating risks, lay beliefs, and informed decisions. Ann Behav Med 2014; 46:322-35. [PMID: 23653418 DOI: 10.1007/s12160-013-9508-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Despite uncertainty regarding the benefits of prostate cancer screening, many men have had a prostate-specific antigen (PSA) test. PURPOSE This study aims to identify classes of reasons guiding men's decisions about prostate cancer screening and predict reasoning approaches by family history and prior screening behaviour. METHODS First-degree relatives of men with prostate cancer (n = 207) and men from the general population (n = 239) of Australia listed reasons they considered when deciding whether to have a PSA test. RESULTS Responses were coded into 31 distinct categories. Latent class analysis identified three classes. The evaluation of risk information cues class (20.9 %) contained a greater number of men with a family history (compared with control and overcome cancer/risk class; 52.7 %). Informed decisions and health system class (26.5 %) included a lower proportion of men who had had a PSA test and greater proportions of highly educated and married men. CONCLUSION Understanding the reasons underlying men's screening decisions may lead to a more effective information provision and decision support.
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Affiliation(s)
- Michelle E McDowell
- Griffith Health Institute, School of Applied Psychology, Griffith University, Mount Gravatt, QLD, 4111, Australia,
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Cantor SB, Volk RJ, Krahn MD, Cass AR, Gilani J, Weller SC, Spann SJ. Concordance of couples' prostate cancer screening recommendations from a decision analysis. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2013; 1:11-9. [PMID: 22272754 DOI: 10.2165/01312067-200801010-00004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To determine whether different utilities for prostate cancer screening outcomes for couples, and husbands and wives separately, lead to incongruent screening recommendations. METHODS We evaluated survey results of 168 married couples from three family practice centers in Texas, USA. Utilities for eight adverse outcomes of prostate cancer screening and treatment were assessed using the time trade-off method. We assessed utilities separately for each partner and jointly for each couple. Using a previously published decision-analytic model of prostate cancer screening, we input the husband's age (starting point) and utilities for outcomes from the husband's, wife's, and couple's perspectives (to adjust for quality of life). Both group-level and individualized models were run. We also asked husbands (and wives) if they intended to be screened (or have their husbands screened) for prostate cancer in the future. RESULTS Husbands' lower tolerance for adverse outcomes (lower utilities) was associated with lower quality-adjusted life expectancy (than their wives) for the choice of screening versus not screening. Depending on the perspective, 48 husbands (28.6%), 89 wives (53.0%), and 58 couples (34.5%) preferred screening in the individual decision-analytic models. Comparing the three perspectives, agreement in model recommendations was greatest between the husbands and the couples (82.1%), intermediate between the wives and couples (63.7%), and lowest between the husbands and wives (55.4%). Using group-aggregated utilities in the decision-analytic model tended to mask the variation in recommended strategies amongst individuals. There was no relationship between screening preferences from the model and the husbands' and wives' reported desire for screening, as the majority of subjects wanted screening. CONCLUSIONS Discordant health preferences may yield conflicting recommendations for prostate cancer screening. The results have broad implications for informed healthcare decision making for couples.
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Affiliation(s)
- Scott B Cantor
- 1 Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA 2 Department of Family and Community Medicine, Baylor College of Medicine and Houston Center for Education and Research on Therapeutics, Houston, Texas, USA 3 Division of Clinical Decision-Making & Health Care, Toronto General Research Institute, Toronto, Ontario, Canada 4 Department of Family Medicine, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA 5 Department of Preventive Medicine and Community Health, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
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Vis JY, van Zwieten MCB, Bossuyt PMM, Moons KGM, Dijkgraaf MGW, McCaffery KJ, Mol BWJ, Opmeer BC. The influence of medical testing on patients' health: an overview from the gynecologists' perspective. BMC Med Inform Decis Mak 2013; 13:117. [PMID: 24106969 PMCID: PMC3842635 DOI: 10.1186/1472-6947-13-117] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 09/12/2013] [Indexed: 11/10/2022] Open
Abstract
Background A medical tests may influence the health of patients by guiding clinical decisions, such as treatment in case of a positive test result. However, a medical test can influence the health of patients through other mechanisms as well, like giving reassurance. To make a clinical recommendation about a medical test, we should be aware of the full range of effects of that test on patients. This requires an understanding of the range of effects that medical testing can have on patients. This study evaluates the mechanisms through which medical testing can influence patients’ health, other than the effect on clinical management, from a gynecologist’s perspective. Methods A qualitative study in which explorative focus groups were conducted with gynecologists, gynecological residents and gynecological M.D. researchers (n = 43). Discussions were transcribed verbatim. Transcriptions were coded inductively and analyzed by three researchers. Results All participants contributed various clinical examples in which medical testing had influenced patients’ health. Clinical examples illustrated that testing, in itself or in interaction with contextual factors, may provoke a wide range of effects on patients. Our data showed that testing can influence the doctor’s perceptions of the patients’ appraisal of their illness, their perceived control, or the doctor-patient relationship. This may lead to changes in psychological, behavioral, and/or medical outcomes, both favorably or unfavorably. The data were used to construct a conceptual framework of effects of medical testing on patients. Conclusions Besides supporting clinical decision making, medical testing may have favorable or unfavorable effects on patients’ health though several mechanisms.
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Affiliation(s)
- Jolande Y Vis
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands.
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19
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Cooperberg MR. Re: Quality-of-life Effects of Prostate-specific Antigen Screening. Eur Urol 2013; 63:1130. [DOI: 10.1016/j.eururo.2013.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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de Bekker-Grob EW, Rose JM, Donkers B, Essink-Bot ML, Bangma CH, Steyerberg EW. Men's preferences for prostate cancer screening: a discrete choice experiment. Br J Cancer 2013; 108:533-41. [PMID: 23361056 PMCID: PMC3593568 DOI: 10.1038/bjc.2013.5] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Screening for prostate cancer (PC) may save lives, but overdiagnosis and overtreatment are serious drawbacks. We aimed to determine men's preferences for PC screening, and to elicit the trade-offs they make. Methods: A discrete choice experiment (DCE) was conducted among a population-based random sample of 1000 elderly men (55–75-years-old). Trade-offs were quantified with a panel latent class model between five PC screening aspects: risk reduction of PC-related death, screening interval, risk of unnecessary biopsies, risk of unnecessary treatments, and out-of-pocket costs. Results: The response rate was 46% (459/1000). Men were willing to trade-off 2.0% (CI: 1.6%–2.4%) or 1.8% (CI: 1.3%–2.3%) risk reduction of PC-related death to decrease their risk of unnecessary treatment or biopsy with 10%, respectively. They were willing to pay €188 per year (CI: €141–€258) to reduce their relative risk of PC-related death with 10%. Preference heterogeneity was substantial, with men with higher educational levels having a lower probability to opt for PC screening than men with lower educational levels. Conclusion: Men were willing to trade-off some risk reduction of PC-related death to be relieved of the burden of biopsies or unnecessary treatments. Increasing knowledge on overdiagnosis and overtreatment, especially for men with lower educational levels, is warranted to prevent unrealistic expectations from PC screening.
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Affiliation(s)
- E W de Bekker-Grob
- Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
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Landstra JMB, Ciarrochi J, Deane FP, Botes LP, Hillman RJ. The psychological impact of anal cancer screening on HIV-infected men. Psychooncology 2012; 22:614-20. [PMID: 22290831 DOI: 10.1002/pon.3040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2011] [Revised: 01/09/2012] [Accepted: 01/11/2012] [Indexed: 12/30/2022]
Abstract
BACKGROUND Anal cancer rates are increasing in HIV-infected men. Screening programmes similar to prostate and cervical cancer have been recommended to reduce morbidity and mortality. Research shows that screening processes have psychological consequences that need to be considered. Limited investigation of the psychological impact of anal cancer screening has been conducted. METHODS A prospective longitudinal survey of 291 men was conducted at three time points over 14 weeks at a public HIV clinic in Sydney, Australia. Self-report questionnaires measuring worry, distress, depression, anxiety, stress and health-related quality of life (SF-12) were collected. RESULTS Those who had a biopsy recommended were significantly more worried about anal cancer, rated their anal health worse and were less optimistic about their future health than the control group who needed no further medical investigation. The group receiving high grade histology results remained worried about anal cancer at time 3. We found no evidence that general anxiety, depression or quality of life was significantly affected by the process. CONCLUSIONS Anal cancer specific worry increases throughout the screening process. Clear communication prior to procedures about the procedure itself, potential adverse events, the recovery process and non-technical explanations of results should be implemented in anal screening programmes.
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Affiliation(s)
- Jodie M B Landstra
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia.
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22
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De Sousa A, Sonavane S, Mehta J. Psychological aspects of prostate cancer: a clinical review. Prostate Cancer Prostatic Dis 2012; 15:120-7. [PMID: 22212706 DOI: 10.1038/pcan.2011.66] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Prostate cancer is the most common non-skin cancer in men. It is fraught with both physical and psychological symptomatology. Depression, anxiety, stress, fatigue, pain and psychosocial factors all affect the patient with prostate cancer. Impotence, erectile dysfunction, sexual issues and incontinence in these patients complicate matters further. Anxiety may exist both before testing and while awaiting test results. Confusion over choosing from various interventions often adds to anxiety and depression in these patients. Various demographic factors and the developmental stage of the couple affect these psychological symptoms. The caregiver may undergo significant psychological turmoil while caring for a patient diagnosed with prostate cancer, which is addressed. The role of nurses in the management of prostate cancer is discussed. The present review looks at psychological issues in patients with prostate cancer from a clinical perspective, with the aim of highlighting these issues for the clinical urologist dealing with these patients. It also explores the consultation-liaison relationship between psychiatrists, psychologists and urologists as a team for the multimodal management of prostate cancer.
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van Vugt HA, Roobol MJ, Busstra M, Kil P, Oomens EH, de Jong IJ, Bangma CH, Steyerberg EW, Korfage I. Compliance with biopsy recommendations of a prostate cancer risk calculator. BJU Int 2011; 109:1480-8. [PMID: 21933335 DOI: 10.1111/j.1464-410x.2011.10611.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
UNLABELLED Study Type - Diagnostic (cohort) Level of Evidence 2b What's known on the subject? and What does the study add? So far, few publications have shown that a prediction model influences the behaviour of both physicians and patients. To our knowledge, it was unknown whether urologists and patients are compliant with the recommendations of a prostate cancer risk calculator and their reasons for non-compliance. Recommendations of the European Randomized study of Screening for Prostate Cancer risk calculator (ERSPC RC) about the need of a prostate biopsy were followed in most patients. In most cases of non-compliance with 'no biopsy' recommendations, a PSA level ≥ 3 ng/mL was decisive to opt for biopsy. Before implementation of the ERSPC RC in urological practices at a large scale, it is important to obtain insight into the use of guidelines that might counteract the adoption of the use of the RC as a result of opposing recommendations. OBJECTIVES To assess both urologist and patient compliance with a 'no biopsy' or 'biopsy' recommendation of the European Randomized study of Screening for Prostate Cancer (ERSPC) Risk Calculator (RC), as well as their reasons for non-compliance. To assess determinants of patient compliance. PATIENTS AND METHODS The ERSPC RC calculates the probability on a positive sextant prostate biopsy (P(posb) ) using serum prostate-specific antigen (PSA) level, outcomes of digital rectal examination and transrectal ultrasonography, and ultrasonographically assessed prostate volume. A biopsy was recommended if P(posb) ≥20%. Between 2008 and 2011, eight urologists from five Dutch hospitals included 443 patients (aged 55-75 years) after a PSA test with no previous biopsy. Urologists calculated the P(posb) using the RC in the presence of patients and completed a questionnaire about compliance. Patients completed a questionnaire about prostate cancer knowledge, attitude towards prostate biopsy, self-rated health (12-Item Short Form Health Survey), anxiety (State Trait Anxiety Inventory-6, Memorial Anxiety Scale for Prostate Cancer) and decision-making measures (Decisional Conflict Scale). RESULTS Both urologists and patients complied with the RC recommendation in 368 of 443 (83%) cases. If a biopsy was recommended, almost all patients (96%; 257/269) complied, although 63 of the 174 (36%) patients were biopsied against the recommendation of the RC. Compliers with a 'no biopsy' recommendation had a lower mean P(posb) than non-compliers (9% vs 14%; P < 0.001). Urologists opted for biopsies against the recommendations of the RC because of an elevated PSA level (≥ 3 ng/mL) (78%; 49/63) and patients because they wanted certainty (60%; 38/63). CONCLUSIONS Recommendations of the ERSPC RC on prostate biopsy were followed in most patients. The RC hence may be a promising tool for supporting clinical decision-making.
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Affiliation(s)
- Heidi A van Vugt
- Department of Urology, Erasmus Medical Center, Rotterdam, the Netherlands
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Cormier JN, Askew RL. Assessment of patient-reported outcomes in patients with melanoma. Surg Oncol Clin N Am 2011; 20:201-13. [PMID: 21111967 DOI: 10.1016/j.soc.2010.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Assessment of patient-reported outcomes (PROs) provides important information to assist with clinical decision making. There has been significant progress in the field of PROs over the past 2 decades with the introduction of validated disease- and symptom-specific instruments. The Functional Assessment of Cancer Therapy-Melanoma (FACT-M) is a melanoma-specific module to accompany the FACT-General, which was validated to assess health-related quality of life for patients with all stages of melanoma. Melanoma-specific health state utilities also have been reported from a number of studies. Assessment of PROs should be incorporated into routine clinical practice to inform clinicians and researchers of the patient perspective for clinical decision making and to evaluate the effects of psychosocial and medical interventions.
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Affiliation(s)
- Janice N Cormier
- Department of Surgical Oncology, Unit 444, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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Capık C, Gözüm S. The effect of web-assisted education and reminders on health belief, level of knowledge and early diagnosis behaviors regarding prostate cancer screening. Eur J Oncol Nurs 2011; 16:71-7. [PMID: 21530397 DOI: 10.1016/j.ejon.2011.03.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 02/26/2011] [Accepted: 03/23/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE OF THE RESEARCH The aim of this study was to investigate the effect of web-assisted education and reminders on health belief, level of knowledge and early diagnosis behaviors regarding prostate cancer screening. METHODS AND SAMPLE In this pretest-posttest longitudinal study, Turkish men over 40 years of age were given an interactive educational session on prostate cancer and prostate cancer screening, and were then given related web-assisted education and consultation for a period of 6 months. As well as the Internet, reminders such as desk calendar, booklets, e-mails and cell phone messages were used in the study. Changes in the screening behaviors, the health belief and knowledge level of patients were examined 3 and 6 months after the interventions. KEY RESULTS During the study, participants' prostate examination rate increased from 9.3% to 19.1% and PSA measurement rate increased from 6.7% to 31.4%. The interventions raised the susceptibility perception on prostate cancer and prostate cancer screening while decreasing the barrier perception (p < 0.05). No change was observed in other health belief components and the level of knowledge. CONCLUSION Web-assisted education and reminders provided positive changes in the barrier and susceptibility perceptions of individuals. Participation in the screening also increased.
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Yasunaga H, Sugihara T, Imamura T. Difference in willingness-to-pay for prostate cancer screening between ill-informed and well-informed men: a contingent valuation survey. Urology 2011; 77:1325-9. [PMID: 21507471 DOI: 10.1016/j.urology.2011.02.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 01/21/2011] [Accepted: 02/01/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To use a contingent valuation method to compare the willingness of well-informed and ill-informed men to pay for PSA screening. Prostate cancer screening by analysis of prostate-specific antigen (PSA) levels has recently been confirmed to reduce prostate cancer death. However, PSA screening is associated with considerable risks, and men should be well informed about the risks before deciding to undergo the test. METHODS A total of 1800 men aged 50-69 years old participated in an Internet-based, computer-assisted questionnaire survey. The subjects were randomly divided into 2 groups. Group 1 (n = 900) was provided with information about the procedure, detection rate, and mortality-reducing effects of PSA screening. Additional information was given to group 2 (n = 900), including the possibility of false-positive or false-negative results, the risks of close examination, and the possibility of overdiagnoses. The willingness to pay (WTP) was assessed using a double-bound dichotomous choice method. RESULTS The average WTP was significantly greater in group 1 than in group 2 ($31.1 vs $25.1, P < .01). Weibull regression analysis showed that patients with a history of receiving PSA screening or with greater incomes had a significantly greater WTP. CONCLUSIONS Although providing information on the risks of PSA screening significantly decreased men's WTP for such tests, the well-informed group was still willing to pay $25.1. These findings suggest that men can balance the potential disadvantages of PSA screening against its effectiveness in saving lives.
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Affiliation(s)
- Hideo Yasunaga
- Department of Health Management and Policy, University of Tokyo Graduate School of Medicine, Tokyo, Japan.
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Kreutzwiser R, de Loë R, Imgrund K, Conboy MJ, Simpson H, Plummer R. Understanding stewardship behaviour: factors facilitating and constraining private water well stewardship. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2011; 92:1104-1114. [PMID: 21185114 DOI: 10.1016/j.jenvman.2010.11.017] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 10/19/2010] [Accepted: 11/22/2010] [Indexed: 05/26/2023]
Abstract
Regulatory frameworks to ensure municipal drinking water safety exist in most North American jurisdictions. However, similar protection is rarely provided to people reliant on water provided from private wells. In Canada, approximately 4 million people depend on privately owned, domestic wells for their drinking water. Numerous studies have shown that people who rely on private wells for their water supplies are at risk from nitrate and bacterial contamination. Given the fact that regulations relating to private wells tend to be weak or poorly enforced, actions taken by well owners to protect their own drinking water safety are extremely important. Drawing on one of the largest and most comprehensive surveys of private well owners ever conducted in Canada or elsewhere, this paper explores factors that influence well owner stewardship behaviour. Key behaviours examined included annual testing of well water and inspection of wells, measures to protect water quality, and proper decommissioning of unused wells. A geographically-stratified survey, sent to 4950 well owners in Ontario, Canada, resulted in an effective response rate of 34% (n = 1567). Logistic regression analyses revealed that motivations for well stewardship behaviours included reassurance, the perception of problems, and knowledge of the environment. Knowing how to perform stewardship behaviours was an important antecedent to action. Barriers to stewardship included complacency, inconvenience, ignorance, cost, and privacy concerns. To promote stewardship, local initiatives, better educational materials, and enforcement through real estate laws are all required. Ultimately, drinking water safety for people reliant on private wells is shown to be a responsibility shared by governments and private well owners.
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Affiliation(s)
- Reid Kreutzwiser
- Department of Geography, University of Guelph, 50 Stone Rd. E., Guelph, ON N1G 2W1, Canada
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Consedine NS, Christie MA, Neugut AI. Physician, affective, and cognitive variables differentially predict initiation versus maintenance PSA screening profiles in diverse groups of men. Br J Health Psychol 2010; 14:303-22. [DOI: 10.1348/135910708x327626] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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van Dam L, Hol L, de Bekker-Grob EW, Steyerberg EW, Kuipers EJ, Habbema JDF, Essink-Bot ML, van Leerdam ME. What determines individuals' preferences for colorectal cancer screening programmes? A discrete choice experiment. Eur J Cancer 2010; 46:150-9. [PMID: 19683432 DOI: 10.1016/j.ejca.2009.07.014] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Revised: 07/03/2009] [Accepted: 07/17/2009] [Indexed: 01/22/2023]
Abstract
INTRODUCTION In many countries uptake of colorectal cancer (CRC) screening remains low. AIM To assess how procedural characteristics of CRC screening programmes determine preferences for participation and how individuals weigh these against the perceived benefits from participation in CRC screening. METHODS A discrete choice experiment was conducted among subjects in the age group of 50-75 years, including both screening-naïve subjects and participants of a CRC screening programme. Subjects were asked on their preferences for aspects of CRC screening programmes using scenarios based on pain, risk of complications, screening location, preparation, duration of procedure, screening interval and risk reduction of CRC-related death. RESULTS The response was 31% (156/500) for screening-naïve and 57% (124/210) for CRC screening participants. All aspects proved to significantly influence the respondents' preferences. For both groups combined, respondents required an additional relative risk reduction of CRC-related death by a screening programme of 1% for every additional 10 min of duration, 5% in order to expose themselves to a small risk of complications, 10% to accept mild pain, 10% to undergo preparation with an enema, 12% to use 0.75l of oral preparation combined with 12h fasting and 32% to use an extensive bowel preparation. Screening intervals shorter than 10 years were significantly preferred to a 10-year screening interval. CONCLUSION This study shows that especially type of bowel preparation, risk reduction of CRC related death and length of screening interval influence CRC screening preferences. Furthermore, improving awareness on CRC mortality reduction by CRC screening may increase uptake.
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Affiliation(s)
- L van Dam
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Centre Rotterdam, Room Ba-393, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
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Hol L, de Bekker-Grob EW, van Dam L, Donkers B, Kuipers EJ, Habbema JDF, Steyerberg EW, van Leerdam ME, Essink-Bot ML. Preferences for colorectal cancer screening strategies: a discrete choice experiment. Br J Cancer 2010. [PMID: 20197766 DOI: 10.1038/sj.bjc.66055666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Guidelines underline the role of individual preferences in the selection of a screening test, as insufficient evidence is available to recommend one screening test over another. We conducted a study to determine the preferences of individuals and to predict uptake for colorectal cancer (CRC) screening programmes using various screening tests. METHODS A discrete choice experiment (DCE) questionnaire was distributed among naive subjects, yet to be screened, and previously screened subjects, aged 50-75 years. Subjects were asked to choose between scenarios on the basis of faecal occult blood test (FOBT), flexible sigmoidoscopy (FS), total colonoscopy (TC) with various test-specific screening intervals and mortality reductions, and no screening (opt-out). RESULTS In total, 489 out of 1498 (33%) screening-naïve subjects (52% male; mean age+/-s.d. 61+/-7 years) and 545 out of 769 (71%) previously screened subjects (52% male; mean age+/-s.d. 61+/-6 years) returned the questionnaire. The type of screening test, screening interval, and risk reduction of CRC-related mortality influenced subjects' preferences (all P<0.05). Screening-naive and previously screened subjects equally preferred 5-yearly FS and 10-yearly TC (P=0.24; P=0.11), but favoured both strategies to annual FOBT screening (all P-values <0.001) if, based on the literature, realistic risk reduction of CRC-related mortality was applied. Screening-naive and previously screened subjects were willing to undergo a 10-yearly TC instead of a 5-yearly FS to obtain an additional risk reduction of CRC-related mortality of 45% (P<0.001). CONCLUSION These data provide insight into the extent by which interval and risk reduction of CRC-related mortality affect preferences for CRC screening tests. Assuming realistic test characteristics, subjects in the target population preferred endoscopic screening over FOBT screening, partly, due to the more favourable risk reduction of CRC-related mortality by endoscopy screening. Increasing the knowledge of potential screenees regarding risk reduction by different screening strategies is, therefore, warranted to prevent unrealistic expectations and to optimise informed choice.
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Affiliation(s)
- L Hol
- Departments of Gastroenterology and Hepatology, Erasmus MC, University Medical Centre, 's-Gravendijkwal 230, Rotterdam, The Netherlands.
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Hol L, de Bekker-Grob EW, van Dam L, Donkers B, Kuipers EJ, Habbema JDF, Steyerberg EW, van Leerdam ME, Essink-Bot ML. Preferences for colorectal cancer screening strategies: a discrete choice experiment. Br J Cancer 2010; 102:972-80. [PMID: 20197766 PMCID: PMC2844026 DOI: 10.1038/sj.bjc.6605566] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: Guidelines underline the role of individual preferences in the selection of a screening test, as insufficient evidence is available to recommend one screening test over another. We conducted a study to determine the preferences of individuals and to predict uptake for colorectal cancer (CRC) screening programmes using various screening tests. Methods: A discrete choice experiment (DCE) questionnaire was distributed among naive subjects, yet to be screened, and previously screened subjects, aged 50–75 years. Subjects were asked to choose between scenarios on the basis of faecal occult blood test (FOBT), flexible sigmoidoscopy (FS), total colonoscopy (TC) with various test-specific screening intervals and mortality reductions, and no screening (opt-out). Results: In total, 489 out of 1498 (33%) screening-naïve subjects (52% male; mean age±s.d. 61±7 years) and 545 out of 769 (71%) previously screened subjects (52% male; mean age±s.d. 61±6 years) returned the questionnaire. The type of screening test, screening interval, and risk reduction of CRC-related mortality influenced subjects’ preferences (all P<0.05). Screening-naive and previously screened subjects equally preferred 5-yearly FS and 10-yearly TC (P=0.24; P=0.11), but favoured both strategies to annual FOBT screening (all P-values <0.001) if, based on the literature, realistic risk reduction of CRC-related mortality was applied. Screening-naive and previously screened subjects were willing to undergo a 10-yearly TC instead of a 5-yearly FS to obtain an additional risk reduction of CRC-related mortality of 45% (P<0.001). Conclusion: These data provide insight into the extent by which interval and risk reduction of CRC-related mortality affect preferences for CRC screening tests. Assuming realistic test characteristics, subjects in the target population preferred endoscopic screening over FOBT screening, partly, due to the more favourable risk reduction of CRC-related mortality by endoscopy screening. Increasing the knowledge of potential screenees regarding risk reduction by different screening strategies is, therefore, warranted to prevent unrealistic expectations and to optimise informed choice.
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Affiliation(s)
- L Hol
- Departments of Gastroenterology and Hepatology, Erasmus MC, University Medical Centre, 's-Gravendijkwal 230, Rotterdam, The Netherlands.
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Ahmed HU, Kirkham A, Arya M, Illing R, Freeman A, Allen C, Emberton M. Is it time to consider a role for MRI before prostate biopsy? Nat Rev Clin Oncol 2009; 6:197-206. [PMID: 19333226 DOI: 10.1038/nrclinonc.2009.18] [Citation(s) in RCA: 220] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The use of MRI in prostate cancer management is controversial and current guidelines underplay its role. Technological advances over the past 5 years, however, demand a re-evaluation of this position. In this article, we propose an increased use of MRI, not only in those with a diagnosis of prostate cancer but also for men before a prostate biopsy. The use of MRI before a biopsy can serve as a triage test in men with raised serum prostate-specific antigen levels, in order to select those for biopsy with significant cancer that requires treatment. This strategy could avoid biopsy, and hence unnecessary treatment, in those with no disease or insignificant cancer. In addition, avoidance of postbiopsy artifact caused by hemorrhage will lead to better local staging accuracy, while determining more accurately the disease burden. This approach could improve risk stratification by selecting those who require adjuvant therapy or dose escalation. Furthermore, MRI evaluation of cancer burden could be important in active surveillance regimens to select those needing intervention.
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Affiliation(s)
- Hashim U Ahmed
- Division of Surgical and Interventional Sciences, University College London, UK.
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Lim LS, Sherin K. Screening for prostate cancer in U.S. men ACPM position statement on preventive practice. Am J Prev Med 2008; 34:164-70. [PMID: 18201648 DOI: 10.1016/j.amepre.2007.10.003] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Revised: 08/17/2007] [Accepted: 10/02/2007] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Prostate cancer is the leading cancer in U.S. men, and the third leading cause of cancer deaths. Principal screening tests for detection of asymptomatic prostate cancer include digital rectal examination (DRE) and measurement of the serum tumor marker, prostate-specific antigen (PSA). There are risks and benefits associated with prostate cancer screening. Randomized controlled trials of screening by DRE and PSA are limited to two previously published studies. Two other large-scale randomized controlled trials are currently in progress. METHODS This study reviewed the efficacy of DRE and PSA for prostate cancer screening found in the medical literature prior to July 2007. RESULTS Applications of PSA screening tests used in clinical practice include (1) a PSA cutoff of 4 ng/ml, (2) age-specific PSA, (3) PSA velocity, (4) PSA density, and (5) percent free PSA. Prostate cancer screening can detect early disease and offers the potential to decrease morbidity and mortality. Prostate cancer screening benefits, however, remain unproven, pending results of ongoing trials. There is currently no convincing evidence that early screening, detection, and treatment improves mortality. Limitations of prostate cancer screening include potential adverse health effects associated with false-positive and negative results, and treatment side effects. CONCLUSIONS The American College of Preventive Medicine concludes that there is insufficient evidence to recommend routine population screening with DRE or PSA. Clinicians caring for men, especially African-American men and those with positive family histories, should provide information about potential benefits and risks of prostate cancer screening, and the limitations of current evidence for screening, in order to maximize informed decision making.
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Affiliation(s)
- Lionel S Lim
- Department of Internal Medicine, Griffin Hospital, Derby, Connecticut, USA
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Carlsson S, Aus G, Wessman C, Hugosson J. Anxiety associated with prostate cancer screening with special reference to men with a positive screening test (elevated PSA) - Results from a prospective, population-based, randomised study. Eur J Cancer 2007; 43:2109-16. [PMID: 17643983 DOI: 10.1016/j.ejca.2007.06.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Revised: 06/05/2007] [Accepted: 06/06/2007] [Indexed: 10/23/2022]
Abstract
Levels of anxiety were assessed through questionnaires completed by 1781 screen-positive (PSA > or = 3 ng/mL) men attending the European Randomised Study of Screening for Prostate Cancer in Gothenburg, Sweden. During the first visit (clinical examination, including biopsies), no anxiety whilst awaiting the PSA test results was reported by 66% and 2% reported high levels of anxiety. A multinomial logistics model for repeated measurements, adjusted for age, PSA level, heredity, biopsy finding and urinary symptoms, revealed that anxiety awaiting the PSA was only influenced (increased) by the existence of previously elevated PSA tests (p<.0001). No anxiety associated with biopsy was reported by 45%, while 6% experienced high levels of anxiety. Levels of anxiety decreased significantly with subsequent rounds of examinations (p<0.0001) and with increasing age (p=0.0016). Anxiety associated with prostate cancer screening in general is low to moderate, even in men with elevated PSA, and severe anxiety affects a smaller group of susceptible men.
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Affiliation(s)
- Sigrid Carlsson
- Department of Urology, Sahlgrenska University Hospital, Bruna Stråket 11 B, SE-413 45 Göteborg, Sweden.
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Dale W, Hemmerich J, Meltzer D. Extending the validity of the Memorial Anxiety Scale for Prostate Cancer (MAX-PC) at the time of prostate biopsy in a racially-mixed population. Psychooncology 2007; 16:493-8. [PMID: 17080494 DOI: 10.1002/pon.1107] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The Memorial Anxiety Scale for Prostate Cancer (MAX-PC) has been validated for assessing men with prostate cancer for cancer-specific anxiety. It was originally validated in a predominantly white population. The MAX-PC Prostate Cancer Anxiety Subscale (MAX-PC-PCAS) may be relevant for measuring cancer-specific anxiety in undiagnosed men at risk for prostate cancer. We assess the validity of the MAX-PC-PCAS at the time of prostate biopsy (n = 178). Questions assessed socio-demographic information, health status, patient-estimated risk of cancer, the Hospital Anxiety and Depression Scale--Anxiety Subscale (HADS-A), and the MAX-PC-PCAS. The patients' most recent PSA was recorded. Cronbach's alpha, inter-item correlations, and Pearson correlations with both the HADS-A and clinical variables were compared with the original validation sample. Our sample was younger (63.1 vs 71.1 years), had a larger fraction of African-Americans (43 vs 10%), and had higher PSAs. Cronbach's alpha was equivalent (0.91 vs 0.90), median inter-item correlation was equivalent (0.63 vs 0.61), and Pearson correlation with HADS-A was higher (0.71 vs 0.57). Anxiety levels were not correlated with PSA levels, and there were minor differences in the validation findings by race. The validity of the MAX-PC-PCAS extends to men without cancer undergoing biopsy and to African-Americans.
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Affiliation(s)
- William Dale
- Department of Medicine, Section of Geriatrics, University of Chicago, Chicago 60637, USA.
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Whynes DK, Philips Z, Avis M. Why do women participate in the English cervical cancer screening programme? JOURNAL OF HEALTH ECONOMICS 2007; 26:306-25. [PMID: 17010459 DOI: 10.1016/j.jhealeco.2006.08.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2004] [Revised: 06/08/2006] [Accepted: 08/25/2006] [Indexed: 05/12/2023]
Abstract
The vast majority of women in England attend for cervical cancer screening. Conventional economic theorising fails to explain why and its predictions are inconsistent with the evidence. Using questionnaire data, we analyse directly motivations for screening attendance. We conclude that regular attendance at screening is driven primarily by a search for reassurance, a sense of duty and herd signalling. It is evident that recognisable sub-groups of attenders exist, in which the configurations of motivational factors differ. Being motivated to attend by physicians is less significant that is widely supposed and is more frequently associated with irregular attendance.
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Affiliation(s)
- David K Whynes
- School of Economics, University of Nottingham, Nottingham NG7 2RD, United Kingdom.
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Katz DA, Jarrard DF, McHorney CA, Hillis SL, Wiebe DA, Fryback DG. Health perceptions in patients who undergo screening and workup for prostate cancer. Urology 2007; 69:215-20. [PMID: 17320653 PMCID: PMC1868466 DOI: 10.1016/j.urology.2006.09.059] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2006] [Revised: 08/06/2006] [Accepted: 09/28/2006] [Indexed: 12/11/2022]
Abstract
OBJECTIVES False-positive screening tests may induce persistent psychological distress. This study was designed to determine whether a positive screening test with negative biopsy findings for prostate cancer is associated with worsened mental health during short-term follow-up. METHODS We conducted a cross-sectional telephone survey of two groups of men approximately 2 months after testing: group 1, 109 men with an abnormal prostate-specific antigen level or digital rectal examination findings but with negative biopsy findings for prostate cancer; and group 2, 101 age-matched primary care patients with PSA screening levels in the reference range (less than 4 ng/mL). Primary outcomes included state anxiety and prostate cancer-related worry. Secondary outcomes included Medical Outcomes Study Short Form 36-item Health Survey subscales and sexual function items. Multivariate regression techniques were used to adjust for differences in baseline covariates. RESULTS Group 1 patients were more worried than group 2 patients about getting prostate cancer (mean worry 3.9 versus 4.5, P = 0.0001, using a 5-point scale, with 1 indicating extreme worry and 5 no worry). Group 1 patients also perceived their risk of prostate cancer to be significantly greater than that of controls (P = 0.001). No significant differences were found across state anxiety or Medical Outcomes Study Short Form 36-item Health Survey subscales. Sexual bother was greater for group 1 patients, with 19% reporting that sexual function was a moderate to big problem compared with 10% of group 2 patients (P = 0.0001). CONCLUSIONS Men with abnormal prostate cancer screening tests report increased cancer-related worry and more problems with sexual function, despite having a negative biopsy result. Effective counseling interventions are needed before prostate cancer screening and during follow-up.
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Affiliation(s)
- David A Katz
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
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Yasunaga H, Ide H, Imamura T, Ohe K. Benefit evaluation of mass screening for prostate cancer: willingness-to-pay measurement using contingent valuation. Urology 2006; 68:1046-50. [PMID: 17113896 DOI: 10.1016/j.urology.2006.06.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2006] [Revised: 05/01/2006] [Accepted: 06/05/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Cancer screening exists to save lives. However, the mortality-reducing effect of prostate cancer screening has not yet been sufficiently demonstrated. Therefore, screening should only be performed in men well informed about the disease. We hypothesized that having sufficient information will reduce men's desire for screening. To verify this hypothesis, we measured the willingness to pay (WTP) for prostate-specific antigen screening using the contingent valuation method. METHODS A computer-based questionnaire was implemented through the Internet for 137 men in Japan aged 40 to 59 years. Participants were randomly assigned to two subgroups: 69 subjects were provided with information about the detection rate, and 68 were provided with additional information such as the failure to demonstrate the mortality-reducing effect of prostate-specific antigen screening to date. All were asked about their WTP by a payment cards approach. RESULTS The mean WTP for prostate-specific antigen screening was 18.90 dollars. Categorical regression analysis suggested that annual income, age, and hospitalization history were factors affecting the WTP. Unexpectedly, the difference in the mean WTP between the ill-informed and well-informed groups was not statistically significant. CONCLUSIONS The contingent valuation method can quantify comprehensive benefits, including not only health outcomes, but also non-health outcomes such as reassurance value. The subjects were not so concerned about the long-term effectiveness of saving lives. Their greatest concern was the detection rate. Their WTP may have reflected their desire for the reassurance that could be obtained by confirming that they had no physical sign of cancer.
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Affiliation(s)
- Hideo Yasunaga
- Department of Planning, Information, and Management, University of Tokyo Hospital, Tokyo, Japan.
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Fowler FJ, Barry MJ, Walker-Corkery B, Caubet JF, Bates DW, Lee JM, Hauser A, McNaughton-Collins M. The impact of a suspicious prostate biopsy on patients' psychological, socio-behavioral, and medical care outcomes. J Gen Intern Med 2006; 21:715-21. [PMID: 16808772 PMCID: PMC1924716 DOI: 10.1111/j.1525-1497.2006.00464.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the psychological, socio-behavioral, and medical implications of apparently false-positive prostate cancer screening results. METHODS One hundred and twenty-one men with a benign prostate biopsy performed in response to a suspicious screening test (biopsy group) and 164 men with a normal prostate-specific antigen (PSA) test result (normal PSA group) responded to a questionnaire 6 weeks, 6 and 12 months after their biopsy or PSA test. RESULTS The mean (+/-SD) age of respondents was 61+/-9 years (range, 41 to 88 years). One year later, 26% (32/121) of men in the biopsy group reported having worried "a lot" or "some of the time" that they may develop prostate cancer, compared with 6% (10/164) in the normal PSA group (P<.001). Forty-six percent of the biopsy group reported thinking their wife or significant other was concerned about prostate cancer, versus 14% in the normal PSA group (P<.001). Medical record review showed that biopsied men were more likely than those in the normal PSA group to have had at least 1 follow-up PSA test over the year (73% vs 42%, P<.001), more likely to have had another biopsy (15% vs 1%, P<.001), and more likely to have visited a urologist (71% vs 13%, P<.001). CONCLUSION One year later, men who underwent prostate biopsy more often reported worrying about prostate cancer. In addition, there were related psychological, socio-behavioral, and medical care implications. These hidden tolls associated with screening should be considered in the discussion about the benefits and risks of prostate cancer screening.
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Affiliation(s)
- Floyd J Fowler
- The General Medicine Division, Massachusetts General Hospital, Boston, MA 02114, USA
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Gwede CK, McDermott RJ. Prostate cancer screening decision making under controversy: implications for health promotion practice. Health Promot Pract 2006; 7:134-46. [PMID: 16410430 DOI: 10.1177/1524839904263682] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Prostate cancer is a major health problem for U.S. men and is characterized by paradoxes and controversies. Despite the wide availability of the prostate-specific antigen (PSA) test, prostate cancer screening remains a controversial practice mainly because the direct impact of screening on mortality is not yet proven. As the relative value of screening, early detection, and treatment strategies continue to be debated, glaring racial-ethnic disparities persist with African American men experiencing excess morbidity and mortality and demonstrating the lowest screening rates among racial-ethnic groups. Given the prevailing controversy, uncertainty, and known disparities, how can health education messages be framed to assist men and their family members? This article highlights the ethnic disparities, paradoxes, and controversies of prostate cancer and identifies critical challenges and opportunities for health educators and clinical practitioners. Implications for health promotion communications and informed decision making in this era of uncertainty are discussed.
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Affiliation(s)
- Clement K Gwede
- Department of Interdisciplinary Oncology/Moffitt Cancer Center at the University of South Florida College of Medicine in Tampa, Florida, USA
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Chan ECY, Barry MJ, Vernon SW, Ahn C. Brief report: physicians and their personal prostate cancer-screening practices with prostate-specific antigen. A national survey. J Gen Intern Med 2006; 21:257-9. [PMID: 16637825 PMCID: PMC1828086 DOI: 10.1111/j.1525-1497.2006.00327.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2005] [Revised: 04/05/2005] [Accepted: 10/05/2005] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is inconclusive evidence that prostate cancer screening with prostate-specific antigen (PSA) reduces mortality. Although PSA testing is widespread, it is unknown how many physicians have taken the PSA test themselves. OBJECTIVE To determine the prevalence of PSA testing among physicians. DESIGN Cross-sectional survey. SUBJECTS A nationwide stratified random sample of urologists (response rate 61%, n=247), Internists (response rate 51%, n=273), and family physicians (response rate 64%, n=249) were surveyed by mail in 2000. After excluding female respondents and men who either reported a positive history of prostate cancer or did not respond to that query, there were 146 urologists, 96 Internists, and 118 family physicians. MEASUREMENTS Whether physicians had undergone prostate cancer screening with PSA. RESULTS Eighty-seven percent (155/178) of male physicians aged, 50 and older and 21% (31/150) of white male physicians under age 50 reported having had a PSA test. More urologists than nonurologists in both age groups reported having had a screening PSA test. CONCLUSION Most physicians aged 50 and older report undergoing PSA testing. This may reflect a belief in its efficacy and contribute to its widespread use.
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Affiliation(s)
- Evelyn C Y Chan
- Division of General Internal Medicine, Department of Medicine, The University of Texas-Houston Medical School, Houston, TX 77030, USA.
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Dale W, Bilir P, Han M, Meltzer D. The role of anxiety in prostate carcinoma: a structured review of the literature. Cancer 2005; 104:467-78. [PMID: 15959911 PMCID: PMC3010360 DOI: 10.1002/cncr.21198] [Citation(s) in RCA: 146] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although the impact of anxiety on patients with some types of cancer is well recognized, to the authors knowledge its impact on patients with prostate carcinoma has not been studied as thoroughly. The authors conducted a systematic review of the medical literature for high-quality articles that quantified anxiety levels in men with prostate carcinoma and identified 29 articles. Using the clinical timeline of prostate carcinoma to organize the articles, cross-sectional studies that reflected anxiety prevalence in populations and longitudinal studies that reflected changes in anxiety over time were identified. Anxiety appeared to fluctuate over the clinical timeline in response to stressors and uncertainty (such as at the time of screening and/or biopsy), rising before these times and falling afterward. Although anxiety levels in men age > 55 years who were at risk for prostate carcinoma were modest (10-15%), multiple studies found that these levels were substantially higher in men who presented for screening (> 50%), and "seeking peace of mind" was the motivation cited most frequently for pursuing screening. Most studies demonstrated a significant decrease in anxiety levels after a normal screening or biopsy result, although the proportion of men who remained anxious afterward did not fall to baseline levels (20-36%). Men who presented for prostate-specific antigen monitoring after treatment had elevated anxiety levels at the time of testing (23-33%). Many years after therapy for localized disease, anxiety levels were lower after prostatectomy (23%) compared with the levels after watchful waiting (31%).
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Affiliation(s)
- William Dale
- Department of Medicine, Section of Geriatrics, The University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA.
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Hewitson P, Austoker J. Part 2: Patient information, informed decision-making and the psycho-social impact of prostate-specific antigen testing. BJU Int 2005; 95 Suppl 3:16-32. [PMID: 15844284 DOI: 10.1111/j.1464-410x.2005.05440.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Paul Hewitson
- Cancer Research UK-Primary Care Education Research Group, Department of Primary Care, University of Oxford, Oxford, UK
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Chan ECY. Promoting an ethical approach to unproven screening imaging tests. J Am Coll Radiol 2005; 2:311-20. [PMID: 17411824 DOI: 10.1016/j.jacr.2004.09.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2004] [Indexed: 10/25/2022]
Abstract
The use of screening imaging technology such as electron beam computed tomography and computed tomographic scans for the early detection of coronary artery disease, lung cancer, and other diseases is rising, even though they have not been proven to reduce disease-specific mortality. Until randomized, controlled trials assess the efficacy of these tests as screening tests, they will remain controversial. It is unclear whether the potential benefits of these screening tests outweigh the risks. In a practice environment in which public demand and enthusiasm for screening is high, radiologists can recognize the ethical issues associated with unproven screening imaging tests; understand current national policies toward professionalism and informed and shared decision making for screening; draw on the lessons learned from the proliferation of another unproven screening test, the prostate-specific antigen blood test for prostate cancer; and work with others in the health care system to promote an ethical approach to screening imaging tests.
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Affiliation(s)
- Evelyn C Y Chan
- Biomedical Ethics, Division of General Internal Medicine, Department of Medicine, The University of Texas-Houston Health Sciences Center, Houston, Texas 77030, USA.
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Abstract
OBJECTIVE The objective of this study was to test the hypothesis that socioeconomic disadvantage results in adverse emotional reactions to a novel, stressful, medical examination. METHODS Sigmoidoscopy screening for colorectal cancer was identified as a potential stressor. A subset of participants (N = 3535) from the U.K. Flexible Sigmoidoscopy Trial completed pre- and postscreening questionnaires regarding psychologic well-being. All trial participants were sent a postscreening questionnaire after 3 months (post-flexible sigmoidoscopy [FS] sample, N = 29,804), including measures of distress (the General Health Questionnaire), anxiety (State-Trait Anxiety Inventory), a single-item measure of bowel cancer worry, and a 6-item measure of positive consequences of screening. Socioeconomic status (SES) was coded from postcodes with the Townsend Index. SES differences in changes in emotional well-being over the course of screening were evaluated in the longitudinal sample. SES differences in postscreening well-being in relation to screening outcome were evaluated in the post-FS sample. RESULTS Bowel cancer worry and anxiety were higher in lower SES groups before screening. Both reduced after screening, but there were no SES differences in the change. In the post-FS sample, there was an SES gradient in anxiety but not in distress. Lower SES groups indicated more positive reactions. There were no interactions between SES and screening outcome for any indicator of well-being. CONCLUSIONS Lower SES was associated with worse psychologic well-being before and after screening, but lower SES participants did not show any differentially greater adverse reactions compared with higher SES participants. Moderately stressful experiences in everyday life do not necessarily more unfavorably affect those with fewer educational and economic resources.
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Affiliation(s)
- Alice E Simon
- Department of Epidemiology and Public Health, University College London, UK
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McNaughton-Collins M, Fowler FJ, Caubet JF, Bates DW, Lee JM, Hauser A, Barry MJ. Psychological effects of a suspicious prostate cancer screening test followed by a benign biopsy result. Am J Med 2004; 117:719-25. [PMID: 15541320 DOI: 10.1016/j.amjmed.2004.06.036] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2003] [Accepted: 06/11/2004] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the psychological implications of an apparently false-positive screening result for prostate cancer. METHODS The sample comprised 167 men with a benign biopsy result in response to a suspicious screening test result (biopsy group) and 233 men with a normal prostate-specific antigen (PSA) test result (control group). The men responded to a questionnaire within about 6 weeks of their biopsy or PSA results. They were asked about demographic characteristics, medical history, psychological effects, biopsy experience, and prostate cancer knowledge. RESULTS The survey response rate was 85% (400/471). The mean (+/- SD) age of respondents was 60 +/- 9 years (range, 40 to 88 years); 88% (n = 350) were white. Forty-nine percent (81/167) of men in the biopsy group reported having thought about prostate cancer either "a lot" or "some of the time", compared with 18% (42/230) in the control group (P < 0.001). In addition, 40% (67/167) in the biopsy group reported having worried "a lot" or "some of the time" that they may develop prostate cancer, compared with 8% (18/231) in the control group (P < 0.001). CONCLUSION Men who underwent prostate biopsy more often reported having thought and worried about prostate cancer, despite having received a benign result. This underrecognized human cost of screening should be considered in the debate about the benefits and harms of prostate cancer screening.
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Rimer BK, Briss PA, Zeller PK, Chan ECY, Woolf SH. Informed decision making: what is its role in cancer screening? Cancer 2004; 101:1214-28. [PMID: 15316908 DOI: 10.1002/cncr.20512] [Citation(s) in RCA: 222] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Interest in informed decision making (IDM) has grown in recent years. Greater patient involvement in decision making is consistent with recommendations to improve health care quality. This report provides an overview of IDM; clarifies the differences between IDM, shared decision making (SDM), and informed consent; and reviews the evidence to date about IDM for cancer screening. The authors also make recommendations for research. We define IDM as occurring when an individual understands the disease or condition being addressed and comprehends what the clinical service involves, including its benefits, risks, limitations, alternatives, and uncertainties; has considered his or her preferences and makes a decision consistent with them; and believes he or she has participated in decision making at the level desired. IDM interventions are used to facilitate informed decisions. The authors reviewed the evidence to date for IDM and cancer screening based primarily on published meta-analyses and a recent report for the Centers for Disease Control and Prevention's Guide to Community Preventive Services. IDM and SDM interventions, such as decision aids, result in improved knowledge, beliefs, risk perceptions, and combinations of these. Little or no evidence exists, however, regarding whether these interventions result in 1) participation in decision making at a level consistent with patient preferences or 2) effects on patient satisfaction with the decision-making process. These variables generally either were not assessed or were not reported in the articles reviewed. Results of interventions on uptake of screening were variable. After exposure to IDM/SDM interventions, most studies showed small decreases in prostate cancer screening, whereas four studies on breast and colorectal cancer screening showed small increases. Few data are available by which to evaluate current practices in cancer screening IDM. Patient participation in IDM should be facilitated for those who prefer it. More research is needed to assess the benefits of IDM/SDM interventions and to tailor interventions to individuals who are most likely to desire and benefit from them. There are many system barriers to IDM/SDM and few tools. More work is needed in this area as well. In addition, research is needed to learn how to incorporate IDM into ongoing clinical practice and to determine whether there are unintended negative consequences of IDM.
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Affiliation(s)
- Barbara K Rimer
- Department of Health Behavior and Health Education, School of Public Health, Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7295, USA.
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Taylor KL, Shelby R, Gelmann E, McGuire C. Quality of life and trial adherence among participants in the prostate, lung, colorectal, and ovarian cancer screening trial. J Natl Cancer Inst 2004; 96:1083-94. [PMID: 15265970 DOI: 10.1093/jnci/djh194] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The National Cancer Institute's Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial was designed to examine whether annual screening tests for these four tumor sites result in reduced disease-related mortality. We assessed the impact of trial participation on both health-related quality of life (HRQL) and trial adherence. METHODS Participants (N = 432; 217 in the control arm and 215 in screening arm) were accrued from the Georgetown University PLCO site from May through December 1998. Screening-arm participants were interviewed by telephone at baseline (prescreening), shortly after notification of screening results (short-term follow-up), and 9 months after notification of screening results (intermediate-term follow up). Control-arm participants completed a baseline and 1-year follow-up assessment. Logistic regression analyses were conducted. RESULTS Participants reported high levels of HRQL and satisfaction with their decision to participate. Screening-arm participants with abnormal screening results had a higher level of intrusive thoughts about cancer than those with all normal results (odds ratio [OR] = 2.9, 95% confidence interval [CI] = 1.3 to 6.3) at the short-term follow-up but not at the intermediate-term follow-up (when abnormal test results were known to be false positive; OR = 1.9, 95% CI = 0.89 to 4.2). Trial adherence was statistically significantly better among participants who had received all normal results in the previous year's screening tests (93.7% versus 78.7%; OR = 3.7, CI = 1.1 to 12.0) than in those who received at least one abnormal result. In the control arm, adherence (defined as returning annual questionnaires) was positively associated with education (OR = 3.4, 95% CI = 1.4 to 8.4) and sex, with women being more likely to return questionnaires than men (OR = 2.1, 95% CI = 1.05 to 4.4). CONCLUSIONS It is feasible to collect HRQL measures as part of a large cancer screening trial. Prior abnormal screening results were related to short-term HRQL but not to intermediate-term HRQL. Trial adherence was poorer among those who had received previous false-positive results. These results suggest several methods for improving adherence in this and other subgroups.
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Affiliation(s)
- Kathryn L Taylor
- Cancer Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, 2233 Wisconsin Ave., NW, Ste. 317, Washington, DC 20007, USA.
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Humphris GM, Field EA. An oral cancer information leaflet for smokers in primary care: results from two randomised controlled trials. Community Dent Oral Epidemiol 2004; 32:143-9. [PMID: 15061863 DOI: 10.1111/j.0301-5661.2004.00129.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate whether primary care patients who claim to smoke tobacco gain greater benefit of a patient information leaflet (PIL) on oral cancer than nonsmokers. METHODS Two studies were conducted. Study 1 examined the research question initially, and Study 2 acted as a replication and inclusion of additional secondary outcome measures. The leaflet was designed and tested in an earlier study. Knowledge of oral cancer was assessed by a previously validated 36-dichotomous-item scale. A single-item question ascertained self-reported smoking status (kappa = 0.94). Study 1 participants were drawn from 14 practices (6 medical, 8 dental). A randomised control group design was adopted. The experimental group received the leaflet on attendance to the practice and then completed the questionnaire. The control group received the questionnaire only. Complete data were collected from 739 respondents. The design of Study 2 was identical; 786 new respondents from 16 practices (7 medical, 9 dental) were collected. RESULTS Both studies confirmed that smokers knew less about oral cancer than nonsmokers (P < 0.05) when access to the leaflet had been denied. On receipt of the leaflet, there was no distinction in oral cancer knowledge between the smoking status categories of respondents. Evidence of reassurance about screening from leaflet exposure was supported by the second study. CONCLUSION This programmed research has demonstrated an effect of a brief PIL to offset the decrement in oral cancer knowledge observed in primary care patients who use tobacco in comparison to their nonsmoking counterparts. The leaflet reduced anxiety about oral health screening in smokers.
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Affiliation(s)
- G M Humphris
- Bute Medical School, University of St Andrews, Bute Medical Buildings, St Andrews, Fife KY16 9TS, Scotland.
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Cullen J, Schwartz MD, Lawrence WF, Selby JV, Mandelblatt JS. Short-term impact of cancer prevention and screening activities on quality of life. J Clin Oncol 2004; 22:943-52. [PMID: 14990651 DOI: 10.1200/jco.2004.05.191] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE There are few data on the short-term effects of participating in cancer prevention activities, undergoing genetic risk assessment, or having routine screening. The objective of this article is to systematically review existing research on short-term effects of prevention, genetic counseling and testing, and screening activities on quality of life. METHODS We conducted a MEDLINE search for original research studies that were published between January 1, 1985, and December 31, 2002, and conducted in North America or Western Europe. Data were abstracted and summarized using a standardized format. RESULTS We reviewed 210 publications. Most studies focused on psychological states (anxiety, depression), symptoms, or general health status. One hundred thirty-one studies used 51 previously validated noncancer instruments. Many researchers (12.6%) also added cancer-specific measures, such as perceived cancer risk or symptom indices. Only one study measured satisfaction or quality of provider-client communication. While one report examined lost workdays, no other economic consequences of short-term outcomes were evaluated. Among seven studies that assessed short-term outcomes preferences, only four specifically used time trade-off or linear rating scale methods. No study used standard gamble or willingness-to-pay methods. The overwhelming majority of research indicated that short-term effects were transient. Only two studies linked short-term effects to long-term cancer-related health behaviors such as repeat screening. CONCLUSION There is considerable heterogeneity in short-term outcome measurement. Clinicians need to be aware of potential for short-term, transient adverse effects. The impact of short-term experiences should to be linked to long-term health status and use of services.
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Affiliation(s)
- Jennifer Cullen
- Department of Oncology, Georgetown University, 2233 Wisconsin Ave NW, Suite 440, Washington, DC, USA.
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